Back to Schizophrenia 4

I had moved away from this topic and on to some other research and writing, but then I watched a film about R.D. Laing, ” Mad to Be Normal”, about the time period from 1965-1970, when Laing operated Kingsley House in London, and it drew me right back into the alternative programs of treatment for people with schizophrenia.

I returned to a few of Laing’s books and Joe Berke’s “I Haven’t Had to Go Mad Here” (1979), as well as John Weir Perry’s “The Far Side of Madness”(1974). Laing, Berke, and Perry subscribed to the view that societal reaction to individuals with psychotic symptoms (or even other emotional/interpersonal disturbances) has typically been to employ various means of control and treatments to transform or even obliterate (electric shock, tranquilizers, etc.) troublesome symptoms. They ask, “troublesome to whom?” According to Laing, Berke, and Perry, it has been “troublesome” to family members, friends, work mates, and the psychiatric profession has been enlisted to “normalize” behavior – sometimes by whatever means possible. In addition, I listened to the recording of my 1993 interview with Joe Berke, which I mentioned in an earlier post about Berke’s book with Mary Barnes, ” Two Accounts of a Journey Through Madness”.

My interest here is in the epistemology of what is considered “mental illness” and how a particular cultural and institutional construction determines approaches to treatments and aspects of marginalization. From Foucault’s notion of discipline and punish (with particular reference to prisons and mental institutions) to Mary Douglas’s ( in her “Purity and Danger”) notion of things out of order being perceived as polluting, people with schizophrenia have historically been warehoused, heavily medicated, and/or otherwise marginalized from any mainstream society. Laing, Berke, and Perry, as well as the relational psychotherapists, Harry Stack Sullivan, Otto Will, and Frieda Fromm-Reichman, approached people with schizophrenia as regular human beings with different behavioral challenges, for whom the need to be able to have genuine communication with others is essential to their healing prognosis. Though Laing’s Kingley Hall and Berke’s Arbours Centre did not use medications, except when a resident was a danger to themselves or others, the development of several anti-psychotic drugs in recent years, has provided options of combination treatments – as explained in my earlier posts. Nevertheless, the temptation to medicate and not provide appropriate psychotherapy for people who have schizophrenia continues to be a significant weakness of contemporary psychiatry.

When I visited one of the Arbours Centre residences in 1993 and talked with several of the guests (residents with schizophrenia), I learned that they had dramatic stories of the contrast between their previous institutional experiences and the structure/non-structure and atmosphere of an Arbours House. The guests experienced what they called a “drug holiday” while at Arbours. They experienced respect. They experienced a balance between structure and freedom. They experienced supportive companionship. They experienced empathic healers who treated them as human beings who had needs for attachment, love, and communication with others.

4 thoughts on “Back to Schizophrenia 4”

  1. Very good series of articles!

    In terms of alternative treatments, a follow-up to Laing’s Kingsley Hall was Loren Mosher’s Soteria project in California in the 1970s. The advantage, at least in terms of results, was that it was designed as a controlled study. Patients/guests were either directed to the state hospital or the Soteria house. Results showed that treatment outcomes were at least as good in the Soteria house as in the hospital. What’s more they didn’t experience the side-effects of high doses of medications!

    While there are newer treatment paradigms such as the Open Dialogue Approach, I feel that the underlying assumptions of the current era make it extremely difficult to revisit and concretely extend the inspiringly humane work of the 60s and 70s. I truly wish it were different!

    In terms of these assumptions, I mean that within the field of mental health the “”bio-psycho-social” approach is now bandied about by everyone. Yet, from my experience the “bio”, namely genetic, is often given undue weight and consideration. This hugely impacts the willingness for folks to undertake a microcosmic look into the vicissitudes of that person’s life within the family nexus. These things are so very complicated and difficult to ascertain. Although as you pointed out, a long time ago Laing, Burke, Esterson, and others did manage to study these interactions systematically.

    This, coupled with the fact that there is still a huge taboo on looking into the intricate workings of family life, makes it monumentally difficult to pursue the lines of approach that were implicit in Bateson’s work, and more explicit in Laing’s.

    Even when it is made overt that no one is “blaming” anyone, and rather we are looking at the effects of patterns of intergenerational trauma (often unconscious), the effect is still the same. People don’t seem to want that. Something is wrong with their child. They go to the clinician. They want the problem fixed. They are busy. It’s such a shame, and it’s really no one’s fault.

    The problem, as I see it, is that the unwillingness to really question the subtle ways in which a person can be disconfirmed etc by a primary care giver is at the heart of the whole problem of proper treatment approaches. What ends up being almost impossible to re-examine (i.e. the subtle attachment problems) ends up appearing as just genetics for most people. Now, I’m not saying that genetics doesn’t have a part to play I just think there is so much more to be explored in the murky waters of complicated family communication problems.

    The problem seems to be an epistemological one. Could it ever really be in the interests of society as a whole to question (however lovingly) the family. I think, now more than ever, this is a huge stumbling block.

    One more thing, as you mentioned the film “Mad to be Normal” I wonder if you’ve seen Ken Loach’s 1971 film “Family Life”? It’s a fantastic exposition of the ideas of Laing and others.

    Hope this finds you well, and that you’re still running!

    Best,
    Janan

    1. Janan, Thanks so much for your well articulated comments. I could not agree more with you regarding our current avoidance of looking deeply into family dynamics as part of our attempts to understand and possibly treat people with schizophrenia. I believe some of our avoidance may come from reacting against some of the “refrigerator mother” blaming from Bettleheim and others. We are careful not to blame the mother now and therefore hesitant to even investigate family dynamics. As I mentioned about the Galvin family with six children who had schizophrenia, why those six and not the others? Could it all have been genetic differences? In “Hidden Valley Road” the author did not seriously investigate family dynamics, and yet there was obviously some significant family dysfunction.
      I may look into the Open Dialogue Approach and check Ken Loach’s “Family Life”. Thanks for mentioning these.
      I am still running. What about you?

  2. Bob- It seems to me that one of the issues with the Galvin family situation could rest on the idea that “schizophrenia” is open to interpretation. For instance, lots of research indicates that folks have had many different diagnoses throughout their psychiatric history.

    Often our experiences of being human don’t fall neatly into the psychiatric categories, which are more arbitrarily arrived at than physical illnesses such as diabetes. Thus, whether six of the children actually had “schizophrenia” is questionable. While it may be true, perhaps a more satisfactory way of looking at it would be something along the lines of the “Post-Cartesian Intersubjective Psychoanalytical” approach beautifully elucidated in this paper:http://www.georgeatwood.com/shattered-worlds—psychotic-states.html

    Furthermore, this approach underscores the deep epistemological issues that are even more foundational than the taboo of questioning the family nexus. Here we find ourselves at the critical juncture of the unconscious materialistic attitudes of the current epoch and the conscious striving to make explicit such assumptions. By doing so, we may have much more clarity in terms of understanding the more extreme states of human experience.

    I’m running when I can; unfortunately, not as much at the moment.

    I had a glance at the rest of your website and noticed an interview with Salvador Minuchin- looking forward to reading the transcription!

    Best,
    Janan

    1. Janan, thanks again. Yes, the larger issue is an epistemological one and the Atwood, et.al. article appropriately identifies the typical western set of assumptions and our essential categorical thinking with epistemological biases. Anthropologists and their ethnographies have had the same challenge as psychologists and psychotherapists in trying to get inside the mind of others.I have argued this in several places throughout my blog and I still intend to post something about the DSM as a political document and manual. As mentioned in the Atwood article, a phenomenological methodology is the best way into the mind of the “other”. This is why I have reviewed several memoirs of people who have been diagnosed with schizophrenia. I believe Esme Weijun Wang’s ” The Collected Schizophrenias” and Elyn Saks’s “The Center Cannot Hold” are fine examples of an insider’s experiences.

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